- MVP Health Care (Tarrytown, NY)
- …achieve this, we're looking for a **Professional, Sub-Acute RN UM Reviewer - Medicare ** to join #TeamMVP. If you have a passion for patient-centered advocacy, ... 2 years of experience in utilization management of sub-acute Medicare reviews + Experience with Medicare guidelines...and UM platforms. + Familiarity with CMS regulations and appeals processes. + Ability to work independently and manage… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …of the electronic payment application for Medicare + Help complete any Medicare audits, medical records requests, and appeals and monitor the outcomes. + ... **Job Summary:** Assist in billing and cash application of Medicaid/ Medicare /DME/Home Infusion claims. Manage open accounts receivable which requires rebilling… more
- Cognizant (Albany, NY)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Director based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/… more
- Cardinal Health (Albany, NY)
- …and evaluating strategic opportunities for all lines of business including Medicare , Medicaid, and various commercial markets. Key responsibilities include managing ... with stakeholders like pharmacies and PSAO leadership, and improving the MAC appeals process. This role is critical for ensuring fair pricing and adherence… more
- CenterWell (Albany, NY)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to ... includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The… more
- Molina Healthcare (Albany, NY)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- Stony Brook University (East Setauket, NY)
- …business functions including but not limited to: billing, claims analysis appeals , follow-up, financial assistance and customer service. **Duties of a Revenue ... on rejected or denied claims, improper payments and coding issues. + Process appeals . + Liaise with third party billing and collection agencies. + Identify issues… more
- CVS Health (Albany, NY)
- …concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - The medical director will perform appeals in their "base plan" ... Two (2) + years of experience in managed care ( Medicare and/or Medicaid) MD or DO; Board certification in...we have an Integrated plan. Experience with managed care ( Medicare and Medicaid) utilization review preferred. **Education** MD (Doctor… more
- Catholic Health (Buffalo, NY)
- …is responsible for the coordination, preparation, and timely filing of the various Medicare , Medicaid, Champus cost reports, surveys, rate reviews, filing of rate ... appeals , determination of state and federal budget impacts on...newly identified initiatives. The position coordinates audits related to Medicare (cost report, wage index, etc.) and Medicaid. The… more
- New York State Civil Service (Queens Village, NY)
- …assist in contacting insurance company for preauthorization payments, and/or file appeals on denials of preauthorization. * Participating in the formulation, ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain certification and Medicaid/ Medicare eligibility… more